Better Vision for the Poor

Several social enterprises are attempting to provide eyeglasses to the 500 million to 1 billion poor people in the world who need them. Some enterprises see the provision of trained optometrists as the key to solving the problem; others are focused on cost reduction; others still are focused on technological innovations. Why haven’t any of these approaches succeeded on a large scale?

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Estimates for the number of poor people worldwide who
need eyeglasses are startling. The World Health Organization
reports approximately 517 million people in developing countries
are visually impaired because they do not have access to
corrective treatment. The Centre for Vision in the Developing
World at Oxford University has a higher estimate: More than 1
billion people need but do not get vision correction. There is a
simple, old, and cost-effective technology to solve this problem—
eyeglasses. Yet the problem persists on a vast scale. For
the poor, eyeglasses often are either inaccessible or unaffordable,
forcing hundreds of millions of people to live below their full
potential.

Visual impairment is more than just a health problem. It has economic, educational, and public safety implications. In Tanzania,
for example, 71 percent of people who are farsighted are dissatisfied
with their ability to do near work, such as winnowing grain, sewing,
reading, and cooking food. But only 6 percent of people in Tanzania
who are farsighted have eyeglasses.1 In India in mid-2000, only 7
percent of the population wore spectacles, whereas about 65 percent
of the population needed them.2

A simple pair of eyeglasses could dramatically improve the lives
of the poor, by increasing earning power and occupational and public
safety, improving educational opportunities, and fostering the
ability to perform everyday tasks. Even the straightforward economic
return from eyeglasses for the poor far exceeds their cost. A
variety of approaches have been tried to solve this problem, using
for-profit businesses, social enterprises, and innovative technologies.
To date, none have succeeded on a large scale.

Given the high economic value and low cost of eyeglasses, it would seem that private companies
could profitably supply eyeglasses to
the poor—an ideal situation for applying
the bottom of the pyramid (BOP)
approach popularized by C.K. Prahalad.
In 2005, Essilor International, a publicly
traded French company, launched
a BOP initiative targeting the Indian
rural poor. But the project has yet to
make a profit.

VisionSpring, founded in 2001 as a nonprofit dedicated to reducing
poverty and generating opportunity in the developing world
through the sale of affordable eyeglasses, uses a social entrepreneurship
approach. In 2009, VisionSpring sold 201,000 pairs of readymade
reading glasses. It is now trying to scale up its efforts and
hopes to sell 1 million pairs of eyeglasses per year by 2012. Yet even
if VisionSpring achieves this goal, the impact is too little, given that
between 500 million and 1 billion people need eyeglasses—and the
number is growing.

Another approach to solving the vision problem emphasizes
technological innovation to provide low-cost, self-adjustable spectacles.
These eyeglasses are called AdSpecs, and they are being
developed by Joshua Silver, a physics professor at Oxford
University. At least two other organizations are also offering adjustable
spectacles, but none has achieved significant scale, probably
because they are not cost-effective and have not gained customer
acceptance from a style perspective.

If the benefits of eyeglasses are so obvious, why has it been so
difficult to solve such an apparently easy social problem?

VISION BARRIERS

Many challenges confront the provision of eyeglasses to the poor in
developing countries. Chief among them are a lack of awareness
about the value of corrected vision, access to eyeglasses, and affordability.
A 2006 study of the principal barriers to eye care in Andhra
Pradesh, India, reported that 23.8 percent of the 2,615 respondents
believed they did not have a serious vision problem, with 23.4 percent
stating that they were able to see adequately, 20.4 percent that
other obligations prevented an eye checkup, and 17.5 percent that
they did not have the money.3

One of the problems is that many poor people do not know that
a simple, affordable product exists to restore their clear vision; they
assume that only expensive eyeglasses will solve their vision problem.
Others do not fully appreciate the benefits of good vision.
VisionSpring relates a case where a farmer’s crop failed after he
planted the wrong seeds because of his poor near vision.

Cultural biases related to comfort and attractiveness also pose
hurdles for the use of eyeglasses. A study in East Timor found that
the chief reasons for unwillingness to use eyeglasses were appearance
(41.1 percent) and embarrassment (37.5 percent).4 In China, some
people mistakenly believe that wearing eyeglasses causes children’s
vision to deteriorate faster. And elsewhere, poor people settle for traditional
medicine, which is not known to correct refractive error.

Poor access is another major barrier. In the developing world,
eyeglasses are primarily available in high-priced urban optical shops.
For the rural poor, a trip to buy glasses is expensive and often prohibitive.
It often requires a daylong trip each way to a nearby city.
Eye screening centers are sparse, especially in rural areas, because
of lack of funding. As a result, primary eye care is largely unavailable
where governments lack the willingness to pay for the services or
where there is not a community base with the ability to pay.

Even if people become aware of and gain access to eyeglasses,
the glasses must become more affordable. In the Tanzania study, 31
percent of the people surveyed were unable to afford eyeglasses at a
price that covered the cost and shipping of the spectacles. The East
Timor study found that 49 percent of rural subjects were unwilling
to pay even $1 for eyeglasses, and only 16 percent were willing to
pay $3. Willingness to pay was higher for the urban poor than the rural poor, and higher for men than women. VisionSpring’s experience
is that most people are willing to pay around 10 percent of
their monthly income, once they experience proper vision. This
implies that eyeglasses have to be priced at about $2.50 to gain wide
acceptance among the poor. A recent study in India provided eyeglasses
free to the subjects. One month after using the eyeglasses,
the subjects were asked how much they would be willing to pay for
the eyeglasses; the median answer was about $4.5

Yet in developing countries, eyeglasses are sold at significant
margins by eye doctors and optical shops. A pair of custom eyeglasses
often costs about $50, a price truly out of reach for poor
people living below the poverty line of about $3 per day. The total
indirect cost of acquiring eyeglasses—including reduced livelihood,
cost of transportation, and doctor fees—can be significantly more
than the cost of the eyeglasses themselves.

Another major barrier to delivering vision correction is the
lack of trained optometrists. Many developing countries have as
few as one optometrist for every 1 million people—the figure for
the United Kingdom is one per 8,000 people. In Mali, the ratio
is one per 8 million, according to the Centre for Vision in the
Developing World. Many developing countries lack sufficiently
trained ophthalmic support personnel, such as assistants and
technicians, and rely too much on highly skilled ophthalmologists
for simple eye screenings. The Andhra Pradesh study found
that 93 percent of those who wore eyeglasses for farsightedness
got a prescription from an ophthalmologist.

To better understand the challenges of providing eyeglasses to the poor, it is useful to examine closely
the work of three providers—Essilor,
VisionSpring, and AdSpecs—each of
which is taking a different approach to
solving the problem.

ESSILOR: BOP APPROACH

Some people believe that the vision crisis
can be solved by using the for-profit model
to tackle the BOP market. The best example
of this approach is Essilor International.
With revenues of $4.2 billion and a global
market share of about 30 percent, Essilor
dominates the global ophthalmic lens industry. Essilor designs, manufactures,
and sells plastic optical lenses in more than 100 countries.
Essilor owns 15 lens manufacturing plants and 311 prescription laboratories,
37 of which are in India. The plants manufacture semifinished
lenses for prescription laboratories, which grind and polish the
lenses to meet specific prescriptions. Finished lenses are then sold
to opticians, optometrists, cooperatives, and optic chain stores.

In 1998, Essilor entered the Indian market after internal market
research showed much growth potential for plastic lenses. At that
time, most people in India used glass lenses; the growth of plastic
lenses (which are lighter, more malleable, and shatter resistant)
was estimated at 20 percent a year. Sales climbed and Essilor
achieved an annual growth rate of 35 percent by 2007. Essilor sold
all its lenses through optical shops. Indian opticians generally realize
a gross margin of 60 percent on the sale of each pair of eyeglasses;
in developed countries, gross margins are typically 100
percent or more.

Because most Indian optical shops were located in urban centers,
70 percent of India’s rural population did not have access to
Essilor’s lenses or services. In the early 2000s, Essilor’s management
began to view the rural population as a large, untapped consumer
market that not only could contribute to Essilor’s growth but
also could allow Essilor to address wide-scale visual impairment.
This seemed to be an ideal application of the BOP proposition.
Because poor roads, communication networks, and other essential
infrastructure made access to the rural market difficult, Essilor
needed to develop an innovative distribution strategy.

In 2005, Essilor teamed up with two highly respected Indian
nonprofit eye hospitals, Aravind and Sankara Nethralaya. The pilot
project started by operating a tele-ophthalmology van and a refraction
van, which visited villages to provide eye care and distribute
corrective spectacles. The model was meant to be neither a corporate
social responsibility venture nor a charity. The expectation was
that serving the rural poor would provide a profitable and significant
growth avenue for Essilor India. And the hope was that Essilor
would scale up the operation; the company estimated that 1,000
vans would be needed to reach 600,000 villages.

During the pilot project, the tele-ophthalmology and refraction
vans hosted two-day eye camps in villages across India. The camps
were able to serve up to 150 patients a day. The tele-ophthalmology
van contained state-of-the-art equipment. It provided screenings
for various eye disorders, such as cataracts, through a satellite connection to a hospital. The optometrists at
the camp screened patients for both nearsighted
and farsighted vision. After a screening,
patients were provided a prescription
and given the opportunity to purchase custom-
made eyeglasses from the refraction
van. The refraction van carried frames,
lenses, a grinding machine, and refraction
equipment. In other words, it was an optical
shop on wheels. Each van carried 200 to
500 frames and approximately 1,000 lenses,
with the capacity to produce roughly 60
custom-made eyeglasses a day.

Essilor paid for the refraction vans, grinding equipment, and
lens material. Each fully stocked van cost the company approximately
$50,000. In addition to funding the vans, Essilor supported
the training of the optometrists. To share in the cost of the project,
the hospitals agreed to fund the tele-ophthalmology vans and all
related operating expenses, such as wages and fuel costs. Revenues
were generated from the sale of the eyeglasses and sponsorships.
Each pair of eyeglasses was priced around $4. Sponsors, such as
local government authorities, NGOs, and philanthropists, provided
support for the eye camps and in return had their organizations’
names on banners.

In 2007, approximately 50 percent of clients screened were provided
prescriptions; of these, roughly 40 percent purchased eyeglasses
from the van. On average, the project sold 35 pairs of
eyeglasses a day. But the revenues earned from the sale of eyeglasses
and sponsorships were not sufficient to cover operating
expenses, let alone make a profit.

To improve financial performance, Essilor has broadened its
product range. In 2010, prices range from $4 to $8. Some of the
cheapest products are ready-made reading glasses, which are
offered as a low-cost option to patients not in a position to buy prescription
spectacles. These low-price products are outsourced from
external providers. Essilor also has streamlined its customer process.
Now, after registration, each patient meets a refractionist, who
performs an automated test on an autorefractor. People with normal
eyesight are selected out. Other patients undergo a detailed
screening using a trial set, to arrive at an exact prescription. If any
clinical issue is diagnosed, the patient is examined by an ophthalmologist
via tele-ophthalmology.

Thanks to these changes in pricing, product mix, and process,
Essilor claims its BOP operation now covers its operating expenses.
Essilor does not charge this initiative overhead and capital costs; only
operational and depreciation costs at the van level are taken into
account. Therefore, the project does not make any profit. After trying
to franchise the vans to local opticians, the company has decided to
operate them on its own and to limit future investments to the
amount of cash generated by the existing vans. In 2010, Essilor was
operating six refraction vans and plans to invest in a few more.

VISIONSPRING: SOCIAL ENTREPRENEURSHIP

Others believe that the vision crisis can best be solved by using a
model based on social entrepreneurship. VisionSpring is perhaps the best example of this movement. Founded in 2001 by Dr. Jordan
Kassalow and Scott Berrie as a nonprofit in the United States and
India, VisionSpring started by providing only ready-made reading
glasses to correct farsightedness. The strategy was adopted because
of the strong link between poor near vision and economic productivity,
and because presbyopia (the progressive deterioration of
near vision) represented about 75 percent of the visual impairment
problem. VisionSpring aimed to take reading glasses out of the
exclusive hands of eye care professionals and make them a consumer
product.

The organization developed an innovative business model
to provide basic screening services and ready-made reading eyeglasses
to people living in rural villages. After assessing multiple
suppliers, management decided that China was the most costeffective
source for the eyeglasses. To reach rural people,
VisionSpring trained local women—“Vision Entrepreneurs”—as
independent commissioned sales representatives to visit villages
and sell reading glasses for under $4 a pair. Vision Entrepreneurs
provided basic screenings, using distance and near eye charts, to
determine the appropriate strength of the lenses. VisionSpring
provided a “business in a bag”—a sales kit containing reading
glasses, screening tools, marketing materials, and a uniform.
Vision Entrepreneurs also underwent a three-day training program
in basic eye care and business management.

To increase its global reach and scale, VisionSpring also developed
a franchise model on a fee-for-service basis. This involved
disseminating its sales kits to other nonprofit and for-profit organizations,
such as BRAC, a microcredit organization in Bangladesh.
Through this franchise model, VisionSpring now has more than
5,000 Vision Entrepreneurs in 11 countries.

Using a wholesale approach, VisionSpring distributes its reading
glasses through pharmacies in urban and rural centers. The organization
is testing this approach with Apollo, one of the largest pharmacy
chains in India. VisionSpring has launched operations in 11
countries in Asia, Latin America, and Africa, with its biggest presence
in India. In 2008, the nonprofit sold 98,000 pairs of glasses,
and in 2009 it sold 201,000, doubling sales for the fifth straight year.
VisionSpring’s objective is to sell 1 million eyeglasses in 2012. Much
of the growth is expected to come from franchising and wholesaling
the business model, to leverage large distribution networks that
already exist in target countries.

In 2009, VisionSpring had revenues of about $250,000, and its
total costs were $1.36 million; the difference was covered by philanthropic
donations and grants. The cost of eyeglasses procured was 13
percent of total costs; field and overhead expenses (for example,
training, marketing, staff salaries, and travel) accounted for the
remainder. The total cost of delivering a pair of glasses was $6.77.

VisionSpring’s 2012 budget anticipates 1 million eyeglasses sold,
with revenues of $1.3 million and total costs of $2.8 million, requiring
a philanthropic subsidy of $1.5 million. Overhead and all field
expenses would account for 71 percent of total costs. Currently, 18
percent of total costs are covered by earned revenue; VisionSpring
expects this ratio to reach 38 percent in 2012, and has a long-term
goal of 100 percent earned revenue coverage. Although VisionSpring
seeks to be self-financing, for now its business model is dependent on philanthropy. Looking ahead, management believes that
VisionSpring will require at least three to five more years of subsidies
before reaching sufficient economies of scale. The break-even
point is estimated at 5 million eyeglasses sold per year.

ADSPECS: TECHNOLOGICAL INNOVATION

Yet another group of people believe that the best way to solve the
vision crisis among the poor is to use technological innovation to
provide low-cost self-adjustable spectacles. The technology enables
untrained wearers to set the right focus for lenses in less than a
minute, greatly reducing the need for trained optometrists. These
adjustable glasses cannot yet help with astigmatism, although about
80 percent of people needing vision correction have such mild
astigmatism that the glasses can still be effective.

Joshua Silver developed one such technology, called AdSpecs, at
Oxford University’s Centre for Vision in the Developing World in
1996. The glasses are round, plastic frames with lenses made of
clear sacs of silicon oil sandwiched between two clear plastic discs.
The two sacs are each connected to a tube and a small syringe that
can be adjusted by turning a dial. As a wearer adjusts the dials, he or
she controls how much fluid is loaded into each sac, thereby changing
its curvature; this fine-tunes the glasses to an individual’s prescription.
Once the lenses are adjusted, the sacs are sealed off
permanently with a small valve and the adjusting mechanisms are
removed. The glasses do look rather klutzy: thick lenses in a dark
tortoiseshell frame.

Silver calls AdSpecs “an ordinary company that’s never made a
profit.” The glasses sell for $19 per pair. Over the last 13 years,
30,000 AdSpecs have been sold to the Ghana Education Ministry,
the U.S. government (which purchased 20,000 glasses to distribute
as humanitarian aid), and other organizations. Clearly, the high
price of AdSpecs is a major drawback. Silver has set an ambitious
goal of distributing a billion glasses at the price of $1 per pair by the
year 2020. He says the key will be making the technology cheaper
and cranking up the volume.

In addition to Silver’s work, new efforts are underway to improve the aesthetics of self-adjustable glasses. A new model, called Eyejusters, is expected in the spring of 2011. Eyejusters differ from
AdSpecs in that they use two lenses that slide across each other
to alter their focus, based on a design pioneered in the 1960s by
Nobel Prize-winning physicist Luis Alvarez. David Crosby, principal
scientist at the Centre for Vision in the Developing World,
said that the move to SlideLens technology allows for three crucial
changes. The lenses no longer need to be round, thus allowing
for more freedom in the design. And because fluid has been
removed from the design, the manufacturing is easier and the
glasses can be produced less expensively; the first generation of
Eyejusters are expected to cost $15. Eyejusters also can be readjusted,
providing more accurate vision correction.

Two Dutch organizations, Focus on Vision Foundation and VU
University Medical Center, are trying to produce low-cost adjustable
eyeglasses as well, though they have received less media attention
than AdSpecs. Both models are based on the Alvarez lenses, but neither
organization has produced the glasses on a mass scale. Focus on
Vision, which is probably further along in the development process, plans to distribute 30,000 eyeglasses in 2010 and says its production
costs are $4 per pair. Its former president, Dr. Ben van Noort, anticipated
that “as soon as Focus Vision makes a million per year, the price will
drop to one euro.”

BETTER VISION FOR THE POOR

Why haven’t these approaches made a significant dent in providing
affordable eyeglasses to the poor? The biggest problem is price.
Many poor people who can afford to pay for eyeglasses do not
perceive their value and are therefore unwilling to pay for them,
and many others simply can’t afford to pay the full cost of the
glasses. There are only four solutions to this problem: increase
the appreciation of eyeglasses’ benefits through education and
awareness, thereby increasing demand and people’s willingness to
pay; reduce the total cost of eyeglasses through technological or
business innovations; subsidize the glasses; or pursue a combination
of these strategies.

The first solution, education and awareness, is probably not feasible
for a private organization. Essilor found that charging $4
resulted in only 40 percent of people who need glasses actually
buying them. The East Timor study found that 49 percent of rural
subjects were unwilling to pay even $1 for eyeglasses, and only 16
percent were willing to pay $3. Even if this study is exceptional, it
is clear that any solution must emphasize dramatic cost reduction.
Essilor’s problem is not that the quality of its products and services
is high, it is that its costs are high from relying on professional
optometrists to customize eyeglasses for individual clients. One
lesson from Essilor is that if the poor are given easy access to eyeglasses,
a significant fraction will purchase them.

VisionSpring significantly reduced costs by substituting a lowskilled
Vision Entrepreneur for a professional optometrist. It also
reduced production costs by centralizing purchasing, sourcing from
China, and providing glasses in a few standardized strengths. In
spite of that, its revenues are not high enough to cover costs. As a
result, VisionSpring needs philanthropic subsidies, which limit its
ability to achieve scale commensurate with the size of the vision
problem. Scaling up is also constrained by limited distribution channels
that serve the poor, especially in rural areas. At the same time,
creating a distribution network dedicated to one product is an
expensive solution. Piggybacking onto an existing distribution network
is more cost-effective, as VisionSpring is doing in its partnership
with BRAC, Women’s Development Business, and others. An
initial drawback of VisionSpring’s approach is that it provided only
reading glasses. This left out the significant number of people suffering
from myopia, especially children. VisionSpring has now started
school-based and other initiatives to provide myopic children and
adults with glasses. The organization has demonstrated that it is feasible
to reduce production costs through centralized purchasing and
to reduce distribution costs by not using highly trained personnel.

The technology innovation approach is also appealing, because
by making the glasses self-adjustable two large cost elements can
be eliminated: optometrists and customized manufacturing. Its biggest
drawbacks are the high cost of producing the eyeglasses and
their poor aesthetic appeal. If the costs can be brought down to $1
to $2 per pair and the eyeglasses can be made more cosmetically pleasing, then the technology approach might solve the blurry
vision problem. But that is a big if—there is little evidence so far of
accomplishing such dramatic cost reduction or design changes.
Even if the cost of producing the adjustable eyeglasses comes down
dramatically, distribution costs can still be a hurdle. VisionSpring
sources the reading glasses at about $1 per pair from China and
sells them at $4 per pair to the consumer; it still needs significant
philanthropic subsidies. Self-adjusting eyeglasses reinforce the lesson
that to reduce total costs it is critical to eliminate trained personnel
in the field. Another useful lesson is that the poor are also
conscious of style in eyeglasses.

The impact of blurry vision is real and extremely costly to the
poor, especially among skilled middle-aged people who rely on clear
near vision to work and among children who need to see the blackboard
to learn. The economic and social benefits of solving this
problem far exceed the costs of providing eyeglasses to all poor
visually impaired people. Yet the problem persists. Despite the evidence,
blurry vision has attracted little attention as a global public
health issue. Because eyeglasses are widely available and affordable
in the developed world, there is a perception that blurry vision does
not create a sociomedical disorder. Thus there is no sense of
urgency about eyeglasses to influence policymakers. Unlike public
health causes such as AIDS, there are no activists shouting that eyeglasses
are a human right. It is distressing that such a simple, inexpensive,
and politically neutral health intervention has been so
underfunded and underutilized in poor countries.

PROPOSED SOLUTION

But the situation is not hopeless. The challenge is to move the spectacles
business from a low volume, high margin approach to a high
volume, low margin one, to gain greater penetration among the
poor. The starting point is to reduce costs as much as possible
while still providing acceptable quality. The standards to judge what
is acceptable have to be from the perspective of a poor person who
does not get any vision correction now, not from the perspective
of an affluent person who receives modern eye care. Our solution
would use a basic screening process that does not require a trained
professional. This sacrifices precision, but that is acceptable
because medical evidence indicates that undercorrection of vision
does not have significant negative side effects. Overcorrection of
vision does have side effects, such as headaches and nausea. The
screening process needs to avoid overcorrection, but that is easy
to achieve using simple techniques. Rather than becoming the final
product, self-adjustable glasses could be used for determining a
patient’s prescription needs without assistance from a high-cost
technically trained professional.

As for the production costs of eyeglasses, they could be reduced
by manufacturing eyeglasses in a large factory, emphasizing scale
economies, centralizing sourcing, and instituting standardization.
(A drawback of the standardization approach to ready-made glasses
is that the prescription strength is the same in both lenses.) Lenses
would be manufactured from the least expensive material, which is
probably acrylic; this is the type of plastic that is used in ready-made
reading glasses sold in the United States. Lenses would be offered
in steps of 0.50 diopters for reading glasses and in steps of 0.25 diopters up to -2.00D for distance glasses; there would be no correction
for astigmatism (which requires customized prescription). We
estimate that, if implemented, this approach would give about 80
percent of the people who require a distance prescription a corrected
vision of 20/40 or better—the level of vision required to drive
in the United States.

One study in India implemented a randomized clinical trial with
poor adults to compare ready-made eyeglasses with customized
spectacles.6 The results showed that although vision is slightly better
with customized spectacles, after one month of use 90 percent
of the subjects were satisfied with ready-made eyeglasses and
planned to continue wearing them. A similar study with Chinese
school-age children led by Yangfa Zeng and published in a 2009
issue of Ophthalmology confirms the high level of satisfaction and
acceptance of ready-made spectacles.

With our approach, there would be a very limited variety of
frame styles, carefully selected on the basis of local preferences.
The factory cost of producing standardized prescription eyeglasses
using simple frames in a country like China would be well below $2
per pair. Distribution costs would be reduced by piggybacking onto
existing networks, such as a microcredit organization, a packaged
consumer goods company, or government offices and agencies.
Overhead would be minimized by localizing costs and by restricting
the scope of the project to one or a few neighboring countries.

Yet even if this proposal were carried out, it is not certain
whether the total costs would result in a pair of eyeglasses that could be priced below what the poor are willing to
pay, even assuming significant scale of operations.
There is also the issue of geographical variation.
The willingness to pay for eyeglasses varies by
country, region, culture, and income level. If willingness
to pay is high enough to cover the total
costs, then there is no need for government intervention.
This could be a profitable business for private
firms, and consistent with the current vogue of
market-based solutions for poverty alleviation.

But if the costs are still too high, then the only
way to cover the gap is through a subsidy. The subsidy
does not need to cover the entire cost of the
glasses, but only the gap between the willingness to
pay and the cost. Given the scale of the problem,
the only source for such large subsidies is the government.
Governments could help to build the
market for eyeglasses by funding education and
awareness campaigns or subsidizing eye care centers.
They also could implement targeted policies,
such as requiring children to get basic eye screening
in schools.

Modern financial markets can provide significant
capital for ventures that are expected to be profitable,
making it easy for businesses to scale up. And governments can use
the treasury for scaling up its projects. But nonprofit organizations
find it difficult to attract the capital needed to scale up and satisfy
designated social needs. Ultimately, it will have to be businesses
and governments that provide eyeglasses to the poor on a large
scale. Nonprofits can advocate and serve as a catalyst to prod governments
and companies to solve the social problem, but they cannot
do it alone. If selling eyeglasses to the poor becomes profitable,
then a nonprofit such as VisionSpring can demonstrate and publicize
the economic viability of this approach—or even morph into a
for-profit company.

Private companies and government intervention, however, are
not mutually exclusive solutions. They can exist side by side. For
example, the condom market in India is divided into three segments:
condoms sold at market prices by private companies; condoms sold
at low prices through social marketing programs and through government
subsidies; and condoms distributed free by the government.
A similar approach might be useful for eyeglasses.

Aneel Karnani is associate professor of strategy at the University of Michigan’s
Ross School of Business.

Bernard Garrette is the Atos Origin Professor of Strategy and Business Policy
at HEC Paris.

Jordan Kassalow is founder and CEO of VisionSpring.

Moses Lee is a lecturer and program manager at the Center for Entrepreneurship
at the University of Michigan College of Engineering.

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